for investigation (sentinel lymph node biopsy) may be required. At this stage, referral to a melanoma surgeon is appropriate. If further tissue is required to be removed, this is referred to as a re-excision. This procedure removes a safe ‘margin’ of healthy tissue around the site the melanoma ensuring complete removal of the melanoma. In addition to the re-excision other investigations are required to determine if the melanoma has spread to other parts of the body. A sentinel lymph node biopsy, which is a surgical diagnostic tool to examine the spread of the disease is required if the melanoma is more than one millimetre deep, ulcerated and its cells are dividing quickly. The sentinel lymph node is the first lymph node that the melanoma cells will be present in if the melanoma has spread. This lymph node is identified and surgically removed for examination. If there are melanoma cells present in the lymph node taken for biopsy, further surgery is required to remove more lymph nodes and possible melanoma cells. In addition to surgery, melanoma that has spread (metastatic) can be treated with radiation therapy, targeted molecular therapy and immunotherapy. The stage of the melanoma will dictate the treatment required. It is important to have the appropriate level of investigation, treatment and follow up for the stage of the melanoma given with the initial diagnosis. The melanoma surgeon will discuss appropriate treatment, the likely outcomes and possible side effects, together with risks and benefits. A group of specialists referred to as a multi-disciplinary team will also be involved with discussing and planning treatment for each individual patient to optimise overall care. Melanoma left untreated or under treated can be fatal. Melanoma detected and treated early results in good outcomes. The message of melanoma continues to be about early detection and prevention. Stay sun smart and check your skin regularly. Most melanomas can develop from a long-standing mole that changes or a new spot that forms on the skin. Warning signs of melanoma are as follows: • An increase in size - mole that expands sideways or becomes raised. • A change in colour – blue, black, pink, red, purple or grey colour may develop in melanoma. • Change in shape/irregular border – in contrast, most harmless moles are smooth and regular. • Itch or bleeding – note this sign is often associated with other noticeable changes. • Recent appearance – a mole or freckle that has appeared recently and is rapidly growing or changing colour. If any of these warning signs appear, get your skin checked as soon as possible. An initial diagnosis of melanoma involves a physical examination, inspection of the mole under a dermascope and an excisional biopsy. An excisional biopsy is a surgical procedure performed to remove the suspicious lesion. A local anaesthetic is injected in the area near the lesion. The lesion and a small area around the lesion will be removed using a scalpel. Stitches are then used to close the wound. This biopsy is then sent to a pathologist for examination; this examination will provide information about the lesion. At this time, if the pathologist has found melanoma cells, the next step involves staging of the melanoma to determine the likelihood of spread and if further treatment is required. In cases where there is a safe margin of healthy tissue and the staging is favourable, further treatment may not be required. If however, the melanoma is greater than one millimetre deep or is ulcerated or has a high mitotic count i.e. is dividing quickly, further surgery including surgical removal of a lymph node pindaramagazine.com.au Pindara Magazine 29
Pindara Private Hospital Magazine - Issue Eight
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